此項研究涉及一些新領域，比如弄清楚每一種激素對男性的作用，以及不同的激素水平如何影響身體機能。根據《新英格蘭醫學期刊》(The New England Journal of Medicine)周三發表的一篇論文，雖然睾酮水平下降是造成中年男性肌肉萎縮的原因，但雌激素水平的降低管控着脂肪的堆積。該論文提供了迄今為止最具說服力的證據，證明雌激素是導致中年男性遇到麻煩的主要因素。這兩種激素都是激發性慾所需的。

Middle-Aged Men Can Blame Estrogen for That Waistline, Too

ByGINA KOLATASeptember 12, 2013

It is the scourge of many a middle-aged man: he
starts getting a pot belly, using lighter weights at the gym and somehow
just doesn’t have the sexual desire of his younger years.

The obvious culprit is
testosterone, since men gradually make less of the male sex hormone as
years go by. But a surprising new answer is emerging, one that doctors
say could reinvigorate the study of how men’s bodies age. Estrogen, the
female sex hormone, turns out to play a much bigger role in men’s bodies
than previously thought, and falling levels contribute to their
expanding waistlines just as they do in women’s.

The discovery of the role of estrogen in men is “a
major advance,” said Dr. Peter J. Snyder, a professor of medicine at the
University of Pennsylvania, who is leading a big new research project
on hormone therapy for men 65 and over. Until recently, testosterone
deficiency was considered nearly the sole reason that men undergo the
familiar physical complaints of midlife.

The new frontier of
research involves figuring out which hormone does what in men, and how
body functions are affected at different hormone levels. While dwindling
testosterone levels are to blame for middle-aged men’s smaller muscles,
falling levels of estrogen regulate fat accumulation, according to a study published
Wednesday in The New England Journal of Medicine, which provided the
most conclusive evidence to date that estrogen is a major factor in male
midlife woes. And both hormones are needed for libido.

“Some of the symptoms
routinely attributed to testosterone deficiency are actually partially
or almost exclusively caused by the decline in estrogens,” said Dr. Joel
Finkelstein, an endocrinologist at Harvard Medical School and the
study’s lead author, in a news release on Wednesday.

His study is only the start
of what many hope will be a new understanding of testosterone and
estrogen in men. Dr. Snyder is leading another study, the Testosterone Trial,
which measures levels of both hormones and asks whether testosterone
treatment can make older men with low testosterone levels more youthful —
by letting them walk more quickly, feel more vigorous, improve their
sexual functioning and their memories, and strengthen their bones.
Smaller studies have been promising but unreliable, and estrogen has not
been factored in.

“We had ignored this
hormone in men, but we are studying it now,” said Dr. Alvin M.
Matsumoto, a testosterone and geriatrics researcher at the University of
Washington School of Medicine and the V.A. Puget Sound Health Care
System, who is a Testosterone Trial researcher. “We are just starting
out on this road.”

Both men and women make
estrogen out of testosterone, and men make so much that they end up with
at least twice as much estrogen as postmenopausal women. As levels of
both hormones decline with age, the body changes. But until now,
researchers have focused almost exclusively on how estrogen affects
women and how testosterone affects men.

Dr. Finkelstein’s study
provides a new road map of the function of each hormone and its behavior
at various levels. It suggests that different symptoms kick in at
different levels of testosterone deficiency. Testosterone, he found, is
the chief regulator of muscle tone and lean body mass, but it takes less
than was thought to maintain muscle. For a young man, 550 nanograms of
testosterone per deciliter of blood serum is the average level, and
doctors have generally considered levels below 300 nanograms so low they
might require treatment, typically with testosterone gels.

But Dr. Finkelstein’s study
found that muscle strength and size turn out to be unaffected until
testosterone levels drop very low, below 200 nanograms. Fat
accumulation, however, kicks in at higher testosterone levels: at 300 to
350 nanograms of testosterone, estrogen levels sink low enough that
middle-aged spread begins.

As for sexual desire and
performance, both require estrogen and testosterone, and they increase
steadily as those hormone levels rise. Researchers say it is too early
to make many specific recommendations, but no one is suggesting that men
take estrogen, because high doses cause feminine features like enlarged
breasts.

Although doctors prescribe
testosterone gels for men whose levels fall below 300 nanograms per
deciliter, that cutoff point is arbitrary, and there is no clinical
rationale for it, Dr. Finkelstein said. Often men take the hormone to
treat complaints like fatigue, depression or loss of sexual desire,
which may or may not be from low levels of testosterone. The data
suggest that men with levels around 300 nanograms who complain of sexual
problems may want to try testosterone, but those who complain of
flagging muscle strength should not blame testosterone deficiency, Dr.
Finkelstein said. But, he added, “symptoms of low testosterone tend to
be quite vague.”

Today, millions of men are using testosterone gels, fueling a nearly $2 billion market.

For their study, Dr.
Finkelstein and his colleagues recruited 400 men aged 20 to 50 who
agreed to have their testosterone production turned off for 16 weeks.
Half then received varying amounts of testosterone, while the other half
also got a drug that shuts off estrogen synthesis so the researchers
could assess the effects of having testosterone but not estrogen.

Now Dr. Finkelstein is repeating the study with older men. The Testosterone Trial is looking at them too.

For that study, Dr. Snyder
and his colleagues recruited nearly 800 men aged 65 and older who have
low testosterone levels. The men take either a placebo or enough
testosterone to bring their level to between 400 and 800. Investigators
are assessing walking speed, sexual functioning, vitality, memory,
red-blood-cell count, bones and coronary arteries. The yearlong study
will be completed next year.

Next, researchers said, they want to do a large study like one conducted with thousands of women
in 2002 that asked about long-term risks and benefits of hormone
therapy. Does testosterone therapy lead, for example, to more prostate
cancer? Does it prevent heart attacks?

“We still don’t know the
answers to the clinical questions,” Dr. Matsumoto said. “Does it prevent
things that are really important?”

Michelle V. Agins/The New York Times

Readers’ Comments

At their best, these are the sorts of wines that amplify the sense of
wonder at the heart of greatness. They are reminders that no matter how
rationally we try to analyze wines, they show their true measure in the
emotions they evoke.

Engel and Gentaz are great examples of wines that express all the
distinctive beauty of their terroirs, enhanced by the personal touch of
the winemaker. These two small family estates share another important
characteristic: they no longer exist.

Few passages in family businesses are more difficult to negotiate than
the leadership transition from one generation to the next. At best, it
occurs seamlessly, the parent ceding control to the child while
remaining available to offer occasional advice and encouragement. But it
may happen abruptly, after sudden illness or death. It may be fierce,
as when Oedipal drama interferes with judgment.

Or, as in the case of Engel and Gentaz, an estate hits a dead end, with no heirs to carry on.

It’s in the nature of things that estates come and go. Most die off
unmourned. Their wines were not distinctive enough, perhaps, to be
irreplaceable. Yet for every great estate like Jean-Louis Chave of the
northern Rhône, said to have made wine continuously since 1481, the
annals are replete with names now consigned to history, their wines to
be savored wistfully or sold at auction for outlandish prices born of
increasing scarcity.

Henri Jayer,
the legendary Burgundian vigneron, died in 2006 after retiring some
years before. His vineyards are now farmed by his nephew by marriage,
Emmanuel Rouget, whose wines are well respected but not revered.

Raymond Trollat was for years the conscience of St.-Joseph, having
adhered to traditional, backbreaking agricultural methods as others were
taking easier paths. He retired in 2005 with no heirs. I read recently
that a bottle of his St.-Joseph had sold at auction for $600, a
ridiculous price for what is essentially a rustic but soulful village
wine, though perhaps not so ridiculous for the spirit of Raymond
Trollat, which is irreplaceable.

Noël Verset played a similar role in Cornas, maintaining the ancient
traditions of this northern Rhône village through many lean years until
the rest of the world learned to appreciate the wines. Mr. Verset
retired and sold off his vines, his wines surfacing occasionally like eloquent voices from the past.

Once, a friend opened a bottle of 1979 Barbaresco from Giovannini
Moresco, a long-gone producer. What a beautiful legacy, pure, pale and
elemental. It came and went so fast, and, sadly, I’ve never seen another
bottle.

Alberico Boncompagni Ludovisi, the prince of Venosa, produced his last
wonderful bottles of Fiorano, his estate within the city limits of Rome,
in 1995. That year, for reasons he did not explain, he tore out his
vineyard. The prince died in 2005, and after years of legal wrangling,
the estate was divided among his heirs, who replanted the vineyard. One day we’ll see whether the new wines bear any relation to the old.

Continuity is easier in some regions. In Bordeaux, for example, where so
many chateaus are in the hands of corporations, it’s more a matter of
replacing employees and carrying on. But Bordeaux is not always so
corporate. Jean-François Fillastre,
the proprietor of Domaine du Jaugaret, one of my favorite small
Bordeaux estates, is 70 and has no heirs. I wonder what will happen to
it.

If life were fair, René Engel would still be in the hands of the Engel
family. Philippe Engel took over the estate in 1981 from his father,
Pierre, who died young, and by all accounts Philippe transformed a good
producer into a terrific one. But he, too, died young, of a heart attack
at 49 in 2005. With no heirs, it was sold to François Pinault, the
billionaire who also owns Château Latour, and is now called Domaine
d’Eugénie and is still discovering its personality.

At the small Engel dinner at DBGB on the Bowery, we drank six bottles of
grand cru Burgundy: Clos Vougeots from 1999, ’96, ’91 and ’90, and
Grands Échézeauxs from ’99 and ’98. As a group, the wines were elegant,
subtle and complex, yet with a touch of rusticity that seemed to give
them individuality. The ’98 Grand Échézeaux especially stood out. It was
beautifully calibrated and clear, spicy, floral and bursting with
energy. The ‘99 Grand Échézeaux likewise showed great finesse, while the
Clos Vougeots were richer and plumper, lovely but maybe not with the
same sense of intricate detail.

We toasted the memory of Philippe Engel, and those who had known him
told stories of this adventurous man who enjoyed boating, parties and
traveling the world.

By contrast, Marius Gentaz never went far from his home in Ampuis. In
many ways, his life had more in common with the 19th century than the
21st.

He farmed less than three acres on the dizzyingly steep slopes of
Côte-Rôtie, and essentially made his wines, labeled Gentaz-Dervieux, by
hand. He began in wine in 1947 with his father-in-law, then worked on
his own from 1952 until 1993. When he retired, his vines went to his
nephew, René Rostaing, who blends them into his excellent Côte-Rôties.
But they are not Gentaz-Dervieux.

At the dinner, put on at Bar Boulud by the Rare Wine Company, an
importer, several dozen of us drank 14 vintages from 1993 back to 1978.
To drink any one of these bottles could have been the zenith of a
wonderful meal; to have 14 was overwhelming. And each seemed to have a
story to tell, about a place and a man and a time when life was lived
locally.

Collectively, these were gentle wines, yet with a tensile strength that
belied their graceful structure. They were savory and meaty, typical of
syrahs from the northern Rhône, yet complex, gorgeously fragrant, mellow
yet insistent.

If I were pressed to reveal my favorites, I would say that I loved the
soft ’93, the ripe ’90 and the ethereal ’83. But the ’88 was almost
otherworldly in its beauty, while the ’87 was surprisingly open, full
and harmonious, and the ’85 still deep and dense with a mosaic of aromas
and flavors that have many years to go to express themselves fully.

It’s bittersweet to drink wines like these, knowing that each opened
bottle is one less to go around. Yet it’s also a time to celebrate that
part of the human spirit that allows us to see beyond ourselves, knowing
that memories travel further than flesh.

2013年9月10日 星期二

2013年9月8日 星期日

Ageing is a daunting process, not least because some of the first things to fail are also the most useful, such as memory, attention and motor skills. The idea that some form of regular mental activity can postpone mental decline is not new. Now researchers have found another: playing a certain type of video game could help the elderly stay sharper for longer http://econ.st/1em4h7X